Dr Meg Arroll, chartered psychologist with a specialist interest in health and wellbeing, discusses why we’re all so anxious, particularly in midlife
You really can blame it on your hormones
Oestrogen has many functions, not just the regulation of fertility. It’s known as a soothing hormone, which helps us feel calm and in control. Therefore, when the levels of oestrogen drop during the perimenopause and menopause, never-before-experienced feelings of anxiety can rear their head. Indeed, anxiety and feelings of low mood are often some of the first menopausal symptoms to develop but are not as commonly associated with the menopause as other, more characteristic symptoms such as hot flushes and night sweats.
I’ve worked with many clients who come to me primarily for anxiety, but when we scratch beneath the surface there are many signs that this new psychological symptom may be due to the perimenopause or menopause rather than a mental health condition. A quite revealing question we ask is whether a bubbling sense of unease is new and seemingly coming out of nowhere as this can be a sign that this psychological symptom is stemming from hormonal fluctuations. Many women have said in session “but I don’t feel like an anxious person” and are incredibly confused as to why, all of the sudden a deep sense of unease has overshadowed their lives.
Being squeezed in the sandwich generation is also a factor
Although for many women the physiological changes during this time can certainly explain skyrocketing anxiety, this is also a point in women’s lives when we are effectively sandwiched with caring responsibilities. As we have children later in life, they may still be home - or, as the cost of living means that finding their own place is put on hold for a few years while they save, many adult kids are moving back in after university or beyond.
This boomerang generation of kids, even if once independent, does place a burden on a household – there’s undoubtedly more washing, worrying and weariness in an overcrowded house. But the main difference in midlife is that there are likely ageing parents that need care too – the burden of which is all-too-often placed on family rather than the care system.
Trying to juggle these dual caring roles when experiencing brain fog, fatigue and anxiety as a result of the menopause can be overwhelming. In my practice, I’ve seen women who started to think that they might be in the early stages of dementia as they just couldn’t keep up with work, family life and the cognitive symptoms of depleting oestrogen. Some of which came to me after seeing their doctors and being prescribed antidepressants.
Medication certainly has its place in mental health conditions but for women experiencing the perimenopause and menopause, antidepressants can’t deal with the underlining physiological changes so often lack effectiveness. But being prescribed such drugs can feel like quite a shock – and this has a psychological impact too. Many of my clients said they no longer recognised themselves and felt as if they were falling down the rabbit hole with the world looking on.
Feeling ignored or invisible also leads to anxiety and low mood
This was evidenced by a recent survey of 2,000 women aged over 50 commissioned by Healthspan, supplier of vitamins, minerals and health supplements, which found that 34% reported feelings of anxiety and 30% had experienced symptoms of depression in relation to the perimenopause and menopause. Respondents also stated that their confidence was affected by symptoms such as weight gain and declining libido.
Coupled with this, nearly a third of the women surveyed said they felt the impact of the perimenopause and the menopause was under-rated, showing a fundamental disparity in women’s experience and how it was perceived by others.
Feeling as though your concerns are not taken seriously can have a significant impact on health. In my academic career, I studied many conditions in which patients reported medical or social delegitimation and the data is clear – when individuals are not listened to, or worse are explicitly told that their symptoms are trivial, and we know that both physical and mental health is negatively affected. The guilt, shame and self-recrimination that can ensue when told that something is ‘natural’ or ‘just a part of getting older’ often turns into a genuine barrier to accessing healthcare – both in terms of overall menopausal symptoms and psychological correlates such as anxiety.
Embarrassing symptoms associated with the menopause may trigger anxiety also
One example of this is bladder weakness. Research by the pelvic floor specialist INNOVO© discovered that just over 40% of women questioned did not tell anyone about their symptoms of urinary incontinence, instead they ‘just got on with it’. Pelvic floor muscle strengthening is extremely effective, some studies demonstrate 90% of people will benefit from this type of exercise. Therefore, the fact that 40% of women in the INNOVO© survey could not openly discuss their symptoms of bladder weakness shows yet another area that we must address, as these respondents stated that incontinence was something they felt they had to cope with rather than remedy.
In an age of unlimited information, this finding seems rather shocking but there are many individuals and groups who are tackling this problem. Elaine Miller, a pelvic health physiotherapist and comedian as Gusset Grippers, is using stand-up comedy to disseminate her expertise to a wider audience, whereby she cunningly overcomes the embarrassment surrounding bladder weakness through laughter. Considering embarrassment was the number one reason why women did not talk about their bladder weakness to healthcare professionals, friends or family, Elaine’s approach may be just what we need to smash through his taboo subject.
Sisters doing it for themselves
In a broader sense, the extended campaign produced by BBC Breakfast and Diane Danzebrink’s #MakeMenopuaseMatter campaign, which is fighting for inclusion of menopause training for GPs and has already led to the introduction of menopause education for all teenage boys and girls within the PSHE curriculum, show the times they are a changing. Members of the public and healthcare professional alike are making their voices heard, all of which helps to reduce women’s feelings of embarrassment, stigma and isolation – this, in turn can help tackle some of the anxiety that stems from the gap between personal experience and the way the outside world responds to health changes.
Finally…worth to bear in mind that anxiety is increasing universally
Young children, teenagers, millennials, men…anxiety appears to be rising in all age and sociodemographic groups, not just midlife women. Like the above examples, there will be many reasons for this, and in my view, one is the uncertainty of the times we are living in. In general, we as humans don’t like unpredictability, so the current political and economic climate in the UK and beyond undoubtably produces nervousness.
It’s my sense that as a society we are currently in what psychologists call a liminal phase, wherein what is known is now behind us but what is to come is yet to materialise - a time and space of being betwixt and between. Here, transition occurs but it can be challenging as social structures and personal beliefs are deconstructed, often resulting in feelings of anxiety and fear. The menopause itself can also been viewed in terms of liminality as identity beliefs, roles and status changes. But as we have seen in recent years, women are emerging with strength, grace and wisdom into the next life phase. Therefore, once the underlying physiological changes of the menopause are addressed, I feel we can combat anxiety with a shift in perspective – of reframing and reclaiming this most important time in our lives.
Dr Meg Arroll is co-author of The Menopause Maze* available from Amazon